Cindy Curtis and Pat Gima both posted about babies who aren't feeding well
in early infancy.  The one due to 18% (!) weight loss and dehydration, the
other from effects of Down Syndrome. I'd like to contribute a bit on both
issues.

Extreme weight loss and dehydration ADD to whatever feeding problems or
management problems which LED to the weight loss.  Cindy states that when
baby stabilized and was discharged, there was another 2 oz weight loss as
soon as she went back to unassisted feeding.  I think that the baby was just
expected to do something before it was physically capable of it.  Also it is
possible that the original causal factors were not observed and remediated,
so this weak infant was back where it started.

  It has been my experience that such babies will do best if fed generously
so they can recover the energy that it takes to feed normally.  It strikes
me that withdrawing feeding support to prevent "nipple confusion" or "finger
confusion" mistakes the problem and misses the definition of nipple
confusion (see article by Secat, Lawrence and Neifert.)  This is a baby who
CAN'T feed, not a baby who WON'T.  Feed the baby the easiest and safest way
possible, and have someone observe the feeding technique to make sure baby
is tolerating it without feeding-related apnea or silent aspiration.  Use
the breast as a pacifier to keep baby interested and positive about being at
breast.  Use a hospt grade pump to keep milk supply bountiful so that any
small efforts at breast produce good milk rewards.  As baby recovers, many
techniques can transition baby back to breast for more and more of the
actual feeding.

I have worked recently with a Down Syndrome baby who was so sleepy and hard
to rouse that he had to be rehospitalized  as he was on his way to starving
to death.  He had a quiet little swallowing disorder, and ultimately needed
OT to help. I suggested that  the mother (a dedicated and experience mother
whose 5th child this is) use a very slow flowing bottle with pumped milk,
and thatshe paced feeds, pulling bottle out of child's mouth frequently to
allow the child extra time to organize a swallow.  With less stress involved
in feeding, baby quit "shutting down".  He gained some weight and energy,
stabilized, and began to be capable over about a 2 month period, of doing
some fairly normal nursing.  His heart is fine, too.  I have seen some
infants with this condition who were quite normal nursers; some have
terrific problems getting through early infancy.  It must be managed on a
case by case basis, and the baby dictates the pace and course of the plan.

Just because the OT may want to use a bottle to get food into the kids
doesn't mean they are doing something wrong.  That may be just the right
tool for the job if the baby cannot nurse.  By the way, when I tried a sip
from a cup with this baby, his low tonality and lack of ability to grove his
tongue had milk all over the place.  Floppy as he was, with his eyes closed,
he splayed his tiny fingers and tried to avert.  He just could not organize
that bolus.  A bottle delivered it further back and pressed his tongue into
a grove, and so long as we pulled the bottle out in a second or two, he
could manage a small swallow without the sensation of drowning.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html